Daring to remove part of the brain, and have that person left able to talk, walk, think and move like they did before, is almost unthinkable.

But for more than 70,000 Australians who can’t control epileptic seizures with medication — about 40 per cent of patients — resecting part of the brain where the seizures begin is the last resort.

After four years of nightly seizures, 18-year-old Rachel Vella reached that point.

Brain surgery was her last hope of a life in which she could drive a car, sleep at a friend’s house, stay out late like other teenagers and live independently as an adult.

What doctors from the Florey Institute of Neuroscience and Mental Health and Austin Hospital planned to do in Rachel’s brain would not have been possible five years ago.

The imaging technology was such that they could not have seen the focal spot from where seizures sparked.

Even 18 months ago, the closest neurologists could have got to pinpointing the hot spot of seizure activity was a tennis ball-sized shape.

With the Illowa teenager’s seizures originating in the centre of the brain’s language area, removing such a large chunk of tissue risked leaving her speech compromised.

Traditional thinking in neurosurgery is “bigger is better” when it comes to brain resection. You’re going in there once, you should take as much as you can to boost the chances of removing the problem.

Rachel being prepared for her scan. Picture:Sarah Matray

But the development of a world-first brain imaging analysis technique, led by Florey Professor Graeme Jackson and PhD student Mangor Pederson, is boosting the power of MRI and finding previously “invisible” epilepsy. It is being hailed as a game-changer to allow more precise brain surgery on focal seizures.

Two weeks ago on May 8, Austin neurosurgeon Professor Gavin Fabinyi removed a sliver of tissue, the circumference of a ballpoint pen, from Rachel’s brain.

It’s the smallest brain resection surgery ever carried out at the hospital.

The imaging research is so groundbreaking — with Rachel the first patient to have this analysis used in an operation — that is yet to be published in a medical journal.

Doctors won’t fully know if the operation has been a success for two years.

But with Rachel seizure-free since the procedure, doctors are cautiously optimistic of success.

“Rachel has the type of epilepsy that in the past usually would not be solved, and certainly would not have been solved to this degree of precision. This is the thing we’ve really got to find now in other such patients, because we can fix the epilepsy if we can find these tiny lesions.”

The first seizure happened when Rachel was 15. She threw the ice-cream sundae she was eating on to the carpet, and sat there with a dazed look while her arm twitched uncontrollably.

Pinpointing the seizure hot spot in Rachel’s brain.

The next one came when she was holding an electric beater. The cake batter splattered across the kitchen as she uncontrollably lifted her hand as her parents Carrol and Frank watched in horror.

“It was school holidays and she’d been out a few times with friends. Did she take drugs? Did she see a bad movie? Where did she put her drink? I know she’s not that type of girl, but ... I’m open to all of this,” Mrs Vella said.

The seizures happened every night for the next three months until she was started on medication, under the care of Royal Children’s Hospital neurologist Dr Simon Harvey.

The first drugs left her entire body covered in hives for two weeks.

The next medication made her uncharacteristically aggressive and angry. One made her lose weight, another made her lose hair. They all made her tired all the time. And still the night time seizures came.

It was almost two years before she told her friends about the epilepsy. “I didn’t want people to treat me differently,” Rachel said.

Doctors gave Rachel a 70 per cent chance of her seizures being significantly reduced or disappearing when they offered her the surgery.

It’s the best odds for this type of risky procedure get.

The risk of stroke or a brain bleed was real, but equally worrying for Rachel, who plans to studying primary school teaching at university next year, was how her speech would be affected.

Radiographer Claire Mulcahy gets Rachel set up in the MRI for her scan. Picture: Sarah Matray

“Even if something small came out of this, it’s nice to know that I’ve tried,” she said.

“I don’t want to go through my life wondering what I could have done if I did the surgery and it worked.”

In operating room four at the Austin Hospital, a team of seven neurosurgeons and neurologists hovered around printout colour copies of PET and MRI scans.

They would use these scans like a Melways, a road map of the brain to correlate with the veins, and folds and valleys of brain tissue, so the scalpel could find the target spot.

What they were searching for was an abnormality, just above her left ear, called Bottom of Sulcus Dysplasia.

Like a birthmark on the brain, it is a malformation so small and indistinct it is almost impossible to find using standard imaging technology.

“It’s incredibly subtle,” would be a phrase constantly repeated by doctors and researchers, all shaking their heads in wonder while looking at the scans, during the four-hour operation.

Like genomics aimed to map all the genes in human DNA through the human genome project, this research area of “connectomics” seeks to identify all neural connections in the brain.

This area of “precision medicine” is a new field of study at the Florey.

Rachel with Professor Graeme Jackson. Picture: Jay Town

Prof Jackson’s analysis technique looks at how parts of the brain are talking to each other, with the needle in the haystack being the area that is “talking too much” to its local environment.

“It’s an amazing concept that you can take out such tiny spots from anywhere in the brain,” Prof Jackson said.

“The language system should be a no-go area. Traditionally if the focal point was in the motor system, we could do a big operation, but do you want to be paralysed for the rest of your life? Or do you want not to be able to speak, but we’ll fix your epilepsy?

“It’s been the deal or the devil. No one could have thought a tiny spot could have driven this sort of epilepsy.”

Four days after surgery, Rachel walks from the Austin Hospital with her waist-length ombre hair hanging over both shoulders. You would not even know she has been a hospital patient.

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